What is Autism?
Autism is a type of lifelong disability that affects how people experience the world.
What Difficulties might people with autism face?
The main characteristics of this are difficulties in:
telling people what they need, and how they feel
meeting other people and making new friends
understanding what other people think.
It also affects how they make sense of the world around them.
They may also exhibit restricted and repetitive behaviour.
Autism is a Developmental Condition
Autism is a condition which challenges the individuals understanding of communication, cognition and human difference.
They have unique and sometimes complex needs.
It can affect how children and adults;
¨See, hear and experience the world (sensory)
In an attempt to make the world less confusing, people with Autism may have rules and rituals (ways of doing things) which they insist upon.
Think of some examples that you have experienced
What is meant by – Autistic spectrum?
Autism is a spectrum condition
This means that although all individuals with autism will experience similar difficulties, the condition will affect them differently in some aspects.
Some individuals can live independently, whilst others with accompany learning difficulties, may require continued specialist support.
Autism is often described as a ‘spectrum disorder’ because the condition affects people in many different ways and to varying degrees.
Asperger’s syndrome is a form of autism, which is a lifelong disability that affects how a person makes sense of the world, processes information and relates to other people.
While there are similarities with autism, people with Asperger’s syndrome have fewer problems with speaking and are often of average, or above average, intelligence.
They do not usually have the accompanying learning disabilities associated with autism, but they may have specific learning difficulties.
1) Suzy (4 years old)
Suzy finds it difficult when other people touch her, even her mum. She flinches and shrinks away when mum tries to give her a cuddle; sometimes she kicks out at her mum when she sits on the edge of Suzy’s bed to tuck her in at night.
2) Mohammed (30 years old)
Mohammed does not have speech and relies on other people to help him express his needs. He has a book with photographs of important people and the main objects and activities that he enjoys. He gets frustrated when other people fail to understand what he wants. Mohammed shows his frustration by banging his book on the table or by slapping himself.
3) Alex (16 years old)
Alex is at school and has additional 1:1 tuition. He is very bright and is expected to do well in his exams. He sometimes gets bullied by his peers and doesn’t have any real friends, partly because of his tendency to bluntly point out other people’s physical characteristics. His tutor has bought a computer programme to help Alex learn about social situations that confuse him, as a way of trying to help address the bullying.
1) It affects around 1 in 100 of the population.
2) It is a developmental disability, which means its impact is seen before the age of 18 years – usually in early childhood.
3) It affects how a person communicates and relates to other people.
4) There is no ‘cure’ for autism.
5) You cannot ‘catch’ autism.
6) There is no medical test for autism.
7) Autism is a condition related to genetic factors.
Diagnosis in Children
- Children can be diagnosed with an autism spectrum disorder (ASD) when they’re quite young, in some cases from the age of two. But not everyone is diagnosed early in life.nIt is quite common for older children, and adults to be diagnosed with ASD, particularly if they don’t have accompanying learning disabilities
- Not drawing the attention of parents/carers attention to objects or events, for example pointing to a toy, book or something that is happening nearby (a child may eventually do this, however later than expected)
- Carrying out activities in a repetitive manner.
- Resistance to change. Emerging difficulties with social interaction, social communication and social imagination.
- Behaviour such as biting, pinching, kicking, pica (putting inedible items in the mouth), or self-injurious behaviour.
Diagnosis in Adults
- Adults can self refer and will need to request a referral to a Psychiatrist or Clinical Psychologist.
- There may be problems within the Triad of Impairments
- Problems with Sensory Issues
- Mental health problems
- Learning difficulties
- Love of routines
- Special interests
The Triad of Impairments
How the imagination of autistic people can differ;
1) People with autism will often develop fixed routines which allow them to cope with the complex world we live in. Fixed routines create a predictable safe world in which to live. Changing these routines can be achieved but any attempt to make a sudden or radical change can be very stressful.
2) This means that learning how to do one task may not be a skill transferable to a similar situation. A person with autism may learn to perform a simple task such as catching a bus at one bus stop but not be able to cope with the bus stopping at a different place.
3) Being confronted with new and different things can be confusing and cause anxiety, and something familiar will offer comfort and reassurance.
Having a special interest which is known and understood and holds no nasty surprises is not an uncommon trait. This can result in an almost obsessional interest and sometimes knowledge can reach an encyclopaedic level.
The Triad of Impairments
1) Poor eye contact
A person with autism will often find it very difficult to initiate and maintain eye contact. This does not mean he or she is not interested or is not listening. It simply means that is difficult.
2) Difficulties with empathizing with other people
People with autism find other people very difficult to understand so can lack empathy and may be unwittingly hurtful.
3) Preferring objects to people
Objects are predictable, understandable and will do exactly the same thing today that they did yesterday. People are complex, moody and may behave in unpredictable ways.
4) Inappropriate interactions – A person with autism may be very friendly and keen to establish social relationships. Because they may lack the basic skills needed to make friends and interact with people, there is always a danger that things will ‘go wrong’
The Triad of Impairments
How the communication of autistic people can differ;
1) Poor development of language
Vocabulary may be limited and perhaps unusual or quaint and not backed up by hand gestures such as pointing or body language to give emphasis.
2) Poor intentional communication
People with autism may prefer to get something themselves rather than ask for it. This may be because they essentially do not understand the purpose of communication.
3) Poor at reading body language
Difficulties with understanding non-verbal communication, or ‘body language’.
4) Limited use of the functions of language This means using language to perform a specific function. People with autism might simply not use some of these functions such as greetings, comments, requests or questions. People with autism might find it difficult to differentiate between these functions and may especially find expressing their own feelings or understanding those of others very difficult.
5) Echolalia is the repeating of a phrase as in echoing something said. “Would you like to sit down?” may produce the response “would you like to sit down?” The person may then sit. The echo is part of processing and understanding.
It may also mean that the phrase has simply not been understood. If so it may be worth simplifying the phrase or splitting into two simpler phrases and trying again.
There is another form where rather than craft a sentence a person, particularly a child, may use a well remembered phrase from a TV show or film that sort of fits the circumstances.
6) Intonation and voice control
There are a number of characteristics that relate to the way speech is made which can be found in people with autism. These include:
Problems with volume sometimes too loud, sometimes too quiet.
The voice may sound mechanical or monotonous.
Enunciation of words can be over-emphasised.
The rate can be too fast or too slow.
What is a ‘meltdown’?
A meltdown is not the same as a temper tantrum. It is not bad of naughty behaviour and should not be considered as such. When a person is completely overwhelmed, and their condition means it is difficult to express that in appropriate way, it is understandable that the result is a meltdown.
Stressful events can make their brain feel overloaded
Emotions get bigger and then become overwhelming
Calming down after a meltdown can take a long time
They might need space or might need to be comforted (you need to judge the situation carefully before you act)
How can others help?
What actions can others take to help?
Focus on the person
Show respect and understand how they feel
Speak calmly and quietly
Be honest if you can’t help them with what they want (but explain how you will try to help them later ie contacting someone that can help)
Always do what you say you are going to do
Go to places shops etc at quieter times
Offer positive reassurance
3. Sensory Issue Reactions
1)“I get really confused when I experience new things. It makes me uncomfortable.“
Some people with autism have said that the world is a confusing place filled with unpredictable sights, sounds and smells that can feel overwhelming at times. It can leave people feeling very anxious.
2) “Sometimes I find it really stressful being around other people and having conversations with them, even family and friends.“
Interacting with other people can be particularly difficulty, making it hard to take part in everyday life with family, friends and work colleagues. Many people with autism find it hard to communicate with people in ways that others take for granted.
Sensory Issue Reactions
The sensory world
In addition to the Triad of Impairments, people with autism may also have unusual reactions to sensory information. Each individual is different and specific sensory stimuli can have a profound effect on their level of arousal, mood and interaction with the world.
They may avoid or seek out specific stimulation such as:
- certain noises
An individual might seek out visual stimulation by staring at objects from unusual angles or spinning and flicking objects under a light.
They may seek physical stimulation by spinning, flapping hands or rocking and may refuse to wear certain items of clothing
Interacting with people with Autism
David (14 years old) picks up an apple and takes a bite of it. It’s just before his lunch and his mum doesn’t want him to spoil his appetite. Which of these options are the best for David’s mum to deliver the message to him?
- David, I can see you’re eating an apple, which means you’re hungry.
Lunch will be ready in 10 minutes. Please wait for your lunch.
- You can’t eat that now David, it’s lunch time soon!
The first option is the best. David has already eaten some of the apple, so he clearly can eat the apple if he wants to.
Therefore the word “can’t” is confusing to David.
Autistic people may get confused and take the meaning of words literally.
May be confused by the phrase ‘That’s cool’ when people use it to say something is good.
Interacting with people with Autism
Ali needs to go to see his Practice Nurse for a blood test to make sure he’s keeping well. He walks into the clinic and the nurse greets him. What would be a good way of her doing this?
- Hello Ali. Give me your arm please.
- Hello Ali. I’m going to put a tiny needle in your arm to take the blood.
It will feel OK. When I take out the needle it is finished. OK?
- Hello Ali. I’m going to take your blood now. It won’t hurt.
The second answer is best.
Saying ‘Give me your arm’ might make Ali think that the nurse wants him to take off his arm and give it to her!
Saying ‘It won’t hurt’ might confuse him as sometimes people with autism get confused by the use of a negative (e.g. ‘won’t).
Ali might therefore think that the nurse is saying that she is going to hurt him.
Sensory Issue Reactions
Some key things to remember about interaction with people with autism.
1) Keep your language simple.
2) Keep facial expressions and gestures simple.
3) Provide visual clues in relation to procedures – what is going to happen next?
Theory of mind development
You and a friend drive to the shops in your car. You park your car in a particular street (Mount Street) and as you both have different shops to visit you arrange to meet back at the car in an hour’s time.
Shortly after parting from your friend, you realize you have left your wallet at home, so you take the car home to fetch it.
When you get back to where you parked before, it is full up, so you have to park in a different street (Park Street). You know that when your friend goes to meet you she will assume that the car is where you originally parked it.
Unless you can find her first, she will go to meet you there.
In this situation you understand that your friend’s belief about the location of the car is false, and that she will act on the basis of this false belief. Developmental studies suggest that children typically develop similar understanding at the age of four
The Sally Anne False Belief Test
The child sits at a table on which there are two dolls, Sally and Anne.
Each doll is placed facing a lidded container: a basket and a box.
The experimenter names the dolls for the child, and then checks that the child has understood which is which.
The experimenter enacts a scenario (previous slide) of hiding a marble in the basket – using one doll (Sally) to ‘hide’ the marble, with the other doll (Anne) looking on.
Sally then ‘leaves the room’ and the marble is re-hidden in the box.
Sally then returns and the experimenter asks the child three questions:
1.‘Where will Sally look for her marble?’ (belief question: the correct answer is ‘in the basket’)
2.‘Where is the marble really?’ (reality question: the correct answer is ‘in the box’)
3.‘Where was the marble in the beginning?’ (memory question: the correct answer is ‘in the basket’) Sally-Anne false belief test.
Number of people who thought sally would look in the box :
Downs Syndrome -14%
This understanding is a core component of theory of mind development.
The majority (85%) of typically developing 5 year olds ‘pass’ the test by answering correctly, whereas the majority of 5 years old with ASD (80%) answer incorrectly by answering or pointing to the box.
SPELL is a framework for understanding and responding to the needs of children and adults on the autism spectrum.
Developed through evidence based practice. The framework is useful in identifying underlying issues, reducing the disabling effects of the condition and providing a starting point for communication.
- Positive approaches and expectations
- Low arousal
Supporting people with autism through structure
Maintaining positive approaches and expectations
Developing empathy for individuals with autism
Adopting a low arousal approach
Creating and maintaining links between the individual, their wider support networks and the community.
Principles For Best Practice
All staff working with adults with autism should:
- Work in partnership with adults with autism and, where appropriate, with their families, partners and carers
- Offer support and care respectfully
- Take time to build a trusting, supportive, empathic and non-judgemental relationship as an essential part of care.
All staff working with adults with autism should have an understanding of the:
nature, development and course of autism
impact on personal, social, educational and occupational functioning
impact of the social and physical environment.
All staff working with adults with autism should be sensitive to issues of sexuality, including asexuality and the need to develop personal and sexual relationships. In particular, be aware that problems in social interaction and communication may lead to the person with autism misunderstanding another person’s behaviour or to their possible exploitation by others.
Principles For Best Practice
- Aim to promote active participation in decisions about care and support self-management
- Maintain continuity of individual relationships wherever possible
- Consider whether the person may benefit from access to a trained advocate.
- Become familiar with recognised local and national sources (organisations and websites) of information and/or support for people with autism
- Be vigilant for unusual likes and dislikes about food and/or lack of physical activity
- Offer advice about the beneficial effects of a healthy diet and exercise taking into account any hyper/hypo sensitivities; if necessary, support referral to a GP or dietician.
Maintaining Social Inclusion
Support the Individual in developing friendship skills. Discuss appropriate and inappropriate forms of friendship.
Encourage the individual to join groups and social activities, if they wish.
Support the development of self confidence/esteem